On Election Day, Republican Sharron Angle told Nevada voters that dismantling the Patient Protection and Affordable Care Act  popularly known as ObamaCare  would be among her top priorities if elected to the Senate.

But Angle didnt enjoy a victory party that night. And while Republicans had much to celebrate on Nov. 2, the reality is this: Denied wins in Nevada and Delaware and a handful of other states, they have a tough choice to make.

They can use valuable congressional time trying to kill ObamaCare outright despite impossible odds, or they can be wiser  if less dramatic  and try to change the flawed legislation step-by-step instead.

As a result of their failure to take the Senate, Republicans dont have the votes to repeal ObamaCare in the next Congress. And its important to realize that they would never have had the votes to actually scrap the legislation. Even with a Senate majority, they would fall short of totals needed to override the inevitable presidential veto.

Nevertheless, some Republicans  including members of the GOPs House and Senate leadership  seem eager to get a repeal vote on the record anyway. But forcing President Obama to use his veto pen wont accomplish anything practically for the American people.

For the sake of Republican fortunes and for the sake of American health care, GOP leaders should consider a more incremental approach. While its not as sexy as outright repeal, killing sections from ObamaCare could have real benefits  and could even lay the groundwork for total repeal sometime in the future.

Republicans should start by seeking to repeal ObamaCares medical-device tax, which penalizes job growth and innovation in one of Americas most advanced industrial sectors at a time when that sector is vulnerable to Chinese and European competition. Several Democratic senators represent states rich in medical-device manufacturing and research jobs, so a bipartisan coalition here is realistic.

It would also be worthwhile to wipe out ObamaCares Medicare Independent Payments Advisory Board (or IPAB), which has way too much power over what kind of care can and cant be reimbursed. Such power could change the way physicians practice, effectively leading to rationing.

ObamaCare also includes new regulations that will add to the cost of insurance, reduce competition among insurers and increase health care bureaucracy. For example, the act forces every insurer to price its plans based on “community rating,” lumping everyone in a region into the same statistical pool to avoid “discrimination.”

So, for example, if insurers want to cut prices for consumers by offering separate plans targeted at older Americans, they cant  because health insurance must be priced as though your 60-year-old aunt faces the same risk of getting pregnant, getting an STD, or getting chicken pox as everyone else. Republicans should work to repeal these mandates.

ObamaCare also suppresses competition by forcing each state into its own health exchange, instead of putting all 50 states into a single, national insurance market. The law is written that way because the president fears that more interstate competition will lead to less health-insurance regulation.

But individual Democrats in the House and Senate might be friendlier to real competition  especially if its modeled after the exchange that every member of Congress enjoys access to.

From a political standpoint, its tempting to ignore these smaller reforms and stick to a scorched-earth strategy, since doing so provides a starker choice for voters in 2012 and 2014. But when it comes to ObamaCare, theres a real danger that the scorched-earth strategy would wind up scorching Republicans.

Thats because ObamaCare is likely to be harder to unscramble in the next few years than it is today. Democratic cheerleaders and Republican critics alike know that most of the middle-class subsidies in the plan kick in just before 2014.

Even if only some of the states implement the law and dole out federal insurance subsidies by then, that could be enough to trigger a sense of dependency among middle-class voters  yes, even conservative middle-class voters.

Remember that Medicare is among the most costly social programs in America today and is the closest thing to socialized medicine in America. Yet even many diehard conservatives who oppose health subsidies and government control of health care have come to rely on Medicare personally.

The analogy to treating a sick patient is an overused cliche in health policy, but it applies well here. When it comes to replacing ObamaCare, starting a successful treatment is better than trying  and failing  to cure the patient overnight.